美国肝脏切除术应用普雷灵手法的现状及影响。
Current Pattern of Use and Impact of Pringle Maneuver in Liver Resections in the United States.
机构信息
Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
出版信息
J Surg Res. 2019 Jul;239:253-260. doi: 10.1016/j.jss.2019.01.043. Epub 2019 Mar 8.
BACKGROUND
Pringle maneuver (PM) is used for inflow vascular control during hepatectomy, but its use remains controversial. We aimed to report its pattern of use and association with postoperative outcomes.
METHODS
We identified hepatectomy patients using the liver-targeted National Surgical Quality Improvement Program database (2014-2016). Associations between PM and posthepatectomy liver failure (PHLF), receipt of blood transfusion, and total hospital length of stay (LOS) were evaluated.
RESULTS
We identified 7870 patients (74.9%) with no Pringle maneuver and 2632 (25.1%) with PM. PM patients were older (median age 61 versus 60 y, P = 0.002) and had higher ASA scores (76.1% versus 71.4% were ASA 3-4, P < 0.001). PM had more malignancy (83.0% versus 73.0%, P < 0.001), neoadjuvant therapy (37.7% versus 28.8%, P < 0.001), total lobectomy (30.6% versus 23.2%, P < 0.001), open resection (90.8% versus 74.9%, P < 0.001), and longer operations (246 min versus 212 min, P < 0.001). PM was associated with longer LOS (0.36 d, 95% confidence interval [CI] 0.11-0.60) and increased risk of PHLF (odds ratio [OR] 1.36, 95% CI 1.11-1.66), although not clinically significant grade B/C PHLF (OR 0.82, 95% CI 0.57-1.19), but was not associated with receipt of perioperative blood transfusions (OR 1.00, 95% CI 0.69-1.64).
CONCLUSIONS
PM is associated with similar clinically significant PHLF and transfusion requirements but longer LOS compared with no Pringle maneuver.
背景
普雷令尔手法（Pringle maneuver，PM）用于肝切除术时的入肝血流控制，但它的应用仍存在争议。我们旨在报告其使用模式及其与术后结果的关系。
方法
我们使用肝靶向国家手术质量改进计划数据库（2014-2016 年）确定了肝切除术患者。评估 PM 与术后肝衰竭（posthepatectomy liver failure，PHLF）、输血和总住院时间（length of stay，LOS）之间的关系。
结果
我们确定了 7870 例（74.9%）未行普雷令尔手法和 2632 例（25.1%）行普雷令尔手法的患者。PM 患者年龄较大（中位年龄 61 岁比 60 岁，P=0.002），ASA 评分较高（76.1%比 71.4%为 ASA 3-4，P<0.001）。PM 患者恶性肿瘤更多（83.0%比 73.0%，P<0.001）、新辅助治疗更多（37.7%比 28.8%，P<0.001）、全叶切除术更多（30.6%比 23.2%，P<0.001）、开放性切除术更多（90.8%比 74.9%，P<0.001），手术时间更长（246 分钟比 212 分钟，P<0.001）。PM 与 LOS 延长（0.36 天，95%置信区间[CI]0.11-0.60）和 PHLF 风险增加（比值比[OR]1.36，95%CI1.11-1.66）相关，尽管不是临床显著的 B/C 级 PHLF（OR 0.82，95%CI0.57-1.19），但与围手术期输血无关（OR 1.00，95%CI0.69-1.64）。
结论
与不使用普雷令尔手法相比，PM 与相似的临床显著 PHLF 和输血需求相关，但 LOS 更长。
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